MEDICARE: DOUGLAS RAPID REHAB, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH5191	FL

General Provider Information

NPI Number	:	1366594145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS RAPID REHAB, PA

Provider Business Mailing Address
First Line	:	4140 NW 12TH ST
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-5816
Country	:	US
Telephone Number	:	954-739-3331
Fax Number	:	954-792-4520

Provider Business Practice Location Address
First Line	:	4140 NW 12TH ST
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-5816
Country	:	US
Telephone Number	:	954-739-3331
Fax Number	:	954-792-4520

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL L DOUGLAS
Credential	:	DC
Telephone Number	:	954-739-3331

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	08/26/2014

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